Bourbon Virus Disease Outbreak in New York State

Outbreak News

Bourbon Virus Disease in New York State (Long Island), USA

Update #1 Date- 04/08/2026

Occurrence Update

New York State has confirmed its first human case of Bourbon virus disease (BRBV), a rare tick-borne viral infection, in Suffolk County, Long Island. The patient, a 67-year-old man, became ill after being bitten by lone star ticks (Amblyomma americanum) while performing landscaping work in his backyard. He initially presented with fever, fatigue, and other symptoms suggestive of Lyme disease and received antibiotic treatment. However, as his condition failed to improve, further laboratory investigations by the New York State Department of Health confirmed acute Bourbon virus infection through a significant rise in virus-specific neutralizing antibody titers. The patient required hospitalization and subsequently recovered.

The case was detected during a surveillance study conducted by Stony Brook Medicine, which analyzed blood samples from 107 patients with suspected tick-borne illnesses between 2019 and 2024. Two individuals showed evidence of previous exposure to Bourbon virus, while one met the criteria for recent infection, representing the first confirmed Bourbon virus case in New York State. Researchers believe the disease is likely underdiagnosed because its clinical presentation resembles other tick-borne illnesses and there are currently no commercially available diagnostic tests. The report highlights the need for strengthened surveillance and increased awareness as the geographic distribution of lone star ticks continues to expand.

About the Disease

Bourbon virus disease is a rare zoonotic tick-borne viral infection caused by the Bourbon virus (BRBV), an RNA virus belonging to the genus Thogotovirus in the family Orthomyxoviridae. The virus was first identified in 2014 in Bourbon County, Kansas, USA, following the death of an infected patient. Since then, only a small number of confirmed human cases have been reported in the United States, primarily in the Midwest, southern, and northeastern regions.

Although Bourbon virus infection is uncommon, it has the potential to cause severe disease requiring hospitalization, particularly among older adults and individuals with underlying medical conditions. Currently, there is no licensed vaccine or specific antiviral therapy, making early recognition and supportive clinical care essential.

Transmission of the Disease

Bourbon virus is transmitted primarily through the bite of infected lone star ticks (Amblyomma americanum). The lone star tick is widely distributed across the eastern, southeastern, and central United States and has recently expanded into northeastern states, including New York. Wildlife such as white-tailed deer, small mammals, and ground-dwelling birds are believed to serve as natural hosts that maintain the virus in nature.

Humans become infected after being bitten by an infected tick during outdoor activities such as gardening, landscaping, farming, hiking, or hunting. At present, there is no evidence of person-to-person transmission of Bourbon virus.

Symptoms of the Disease

Symptoms generally appear 2–7 days after a tick bite and are often similar to those caused by other tick-borne diseases, making diagnosis difficult. Common clinical features include:

  • Fever
  • Fatigue and weakness
  • Headache
  • Muscle and joint pain
  • Rash
  • Nausea and vomiting
  • Loss of appetite
  • Leukopenia (low white blood cell count)
  • Thrombocytopenia (low platelet count)

Diagnosis and Treatment

Diagnosis of Bourbon virus disease is challenging because routine commercial diagnostic tests are not available. Confirmation is performed in specialized public health laboratories using reverse transcription-polymerase chain reaction (RT-PCR) during the early stage of illness or by detecting virus-specific neutralizing antibodies in paired blood samples.

There is no specific antiviral treatment for Bourbon virus disease. Management is supportive and includes adequate hydration, fever and pain control, monitoring of blood cell counts, and treatment of complications. Patients with severe illness may require hospitalization. Antibiotics are ineffective against Bourbon virus because it is a viral infection.

Prevention and Control

As no vaccine is currently available, prevention focuses on reducing exposure to tick bites.

Recommended preventive measures include:

  • Use EPA-approved insect repellents containing DEET, picaridin, or IR3535.
  • Wear long-sleeved clothing, long trousers, and closed shoes while in grassy or wooded areas.
  • Treat clothing and outdoor gear with permethrin.
  • Avoid walking through tall grass and dense vegetation whenever possible.
  • Perform thorough tick checks after outdoor activities and remove attached ticks promptly using fine-tipped tweezers.
  • Shower soon after returning indoors to help detect and remove unattached ticks.
  • Strengthen public health surveillance, improve laboratory diagnostic capacity, and educate communities and healthcare providers about emerging tick-borne diseases.

Early recognition of symptoms following a tick bite and prompt medical evaluation remain the most effective strategies for reducing complications associated with Bourbon virus disease.

References

  1. FOX Weather. First case of tick-borne Bourbon virus confirmed in New York State on Long Island.
  2. Kharat V, et al. Bourbon Virus: A Narrative Review. Viruses. 2022;14(12):2794. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9796220/

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